学龄期注意缺陷/多动障碍儿童血铅水平及其与社会功能情况分析

Blood lead level and its correlation with social functions in school-age children with attention deficit/hyperactivity disorder

目的分析学龄期注意缺陷/多动障碍(ADHD)儿童环境铅暴露情况,并进一步分析各年份、各亚型ADHD儿童铅暴露水平以及不同血铅水平下的社会功能情况。方法招募2016年1月-2019年12月至苏州大学附属儿童医院儿童保健科就诊的4590例ADHD儿童(ADHD组),并选取同期以注意力不集中和/或多动、冲动就诊但未达到诊断标准的2264名儿童(非ADHD组)。对所有儿童采集清晨空腹静脉血,采用原子吸收光谱法进行测定血铅水平。应用Weiss′s功能性缺陷程度评定量表(WFIRS-P)对所有儿童社会功能进行评价。结果2016-2019年学龄期ADHD患儿血铅整体水平呈逐年下降趋势。ADHD组儿童血铅水平高于非ADHD组,差异具有统计学意义(t=2.659,P=0.008)。混合型ADHD患儿血铅水平≥50μg/L的比例最高。混合型组ADHD患儿血铅水平高于注意缺陷型组和多动冲动型组(H=14.629,P=0.001)。ADHD儿童在不同血铅水平下社会功能差异无统计学意义(P>0.05)。非ADHD儿童在不同血铅水平下社会活动维度差异有统计学意义(P=0.044)。结论近年来儿童铅暴露水平呈下降趋势,对于以注意力不集中和/或冲动多动为主诉就诊的儿童来讲,低水平铅暴露仍需引起重视。

Objective To investigate the environmental lead exposure of school-age children with attention/deficit hyperactivity disorder(ADHD),and to further analyze the correlation between the lead exposure levels of ADHD children in different years and subtypes,as well as the social functions under different blood lead levels.Methods A total of 4590 ADHD children were recruited as ADHD group from January 2016to December 2019in the Department of Child Health Care in Children′s Hospital of Soochow University.Meanwhile,2264children with inattention and/or impulsive hyperactivity symptoms but not meeting the diagnostic criteria were selected as non-ADHD group.Fasting venous blood was collected from all children in the morning,and the blood lead level was determined by atomic absorption spectrometry.All children′s social functions were evaluated by Weiss Functional Impairment Rating Scale-Parent Report(WFIRS-P).Results From 2016to 2019,the overall blood lead level of ADHD children showed a downward trend year by year.The blood lead level of children in ADHD group was higher than that of children in non-ADHD group(t=2.659,P=0.008).The proportion of blood lead level≥50μg/L in children with combined ADHD was the highest.The blood lead level of children with combined ADHD was higher than that of predominantly inattentive ADHD group and predominantly hyperactive/impulsive ADHD group(H=14.629,P=0.001).There was no significant correlation between blood lead level and six dimensions of social functions in ADHD children,but the score of social activities was significanty higher in non-ADHD children with blood lead level<50μg/L(t=2.016,P<0.05).Conclusions In recent years,the level of lead exposure in children shows a downward trend.For children with inattention and/or impulsive hyperactivity as the main symptoms,attention still should be paid to low level of lead exposure.